Trying to avoid falling off the cliff

Seniors making the case for expansion of Medicare program

TIME IS OF THE ESSENCE for Mary Napolitano. The Somerville resident starts each month with $900 in Social Security income. Subtract $545 for rent and heat. Subtract a little more ($55) for her monthly MBTA bus fare, and another $70 for uncovered medications and copayments. The bills add up, and Napolitano has $230 in expendable income by the end.

Napolitano is almost 64 years old, and she dreads turning 65, when she will no longer be eligible for MassHealth and under current rules won’t be eligible for a Medicare program that would keep her medical bills in check.

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Advocates describe Napolitano’s situation as “falling off the cliff” – the time when her age, her income, and her assets combine to plunge her into an abyss between two government health care programs. (All numbers in this story are for single persons.)

MassHealth cuts people loose when they turn 65 if they have more than $2,000 in assets or a life insurance policy. Napolitano has a life insurance policy, so that would make her ineligible for MassHealth.

The Medicare program, called Medicare Savings, is a 53-year-old initiative that assists low-income seniors over 65 with copays, premiums, deductibles, and prescription coverage. It covers Medicare Part B Premium (at $135.50 per month) and automatically enrolls members in the federal Extra Help program (approximately $4,000 annually), which helps cover deductibles, medications, and additional expenses.

To qualify for Medicare Savings in Massachusetts, a person must have income below 135 percent of the federal poverty level, or less than $16,400. Napolitano would meet that qualification, since her income is just $900.

But the Medicare program also has an asset threshold. Anyone with assets greater than $7,560, including life insurance, is ineligible. That’s where Napolitano falls off the cliff.

Twelve states including Mississippi and Alabama, have passed laws expanding access to Medicare Savings since the inception of the program in 1988. Massachusetts has not, so when Napolitano heard that Gov. Charlie Baker’s fiscal year 2020 budget includes a proposal expanding eligibility for Medicare Savings, she considered it a tentative godsend.

“I have asthma, and a kidney that’s only functioning at 30 percent, so this is important,” she said.

With four specialists, Napolitano has been able to keep her chronic kidney disease under control. She’s concerned that once she loses access to MassHealth, and doesn’t qualify for the Medicare Savings, she won’t be able to see those specialists any longer.

If the bill does not pass, Napolitano’s contribution to her medical expenses will go up to at least 25 percent of her income, as opposed to the 2 to 3 percent the change would allow.

Legislation to expand eligibility for Medicare Savings was filed originally in 2015, but it failed to make it through hurdles in the last two legislative sessions.

Over the past four years, hundreds of seniors have delivered thousands of postcards to the governor’s office, and dozens have testified at committee hearings. Their pleas caught the attention of Health and Human Services Secretary Marylou Sudders. She flagged the issue for Baker, who included aspects of the bill’s eligibility program into his budget.

Baker’s proposal would allow seniors with an income up to $20,000 per year (165 percent of the federal poverty level) to be eligible. The current limit is $16,400 (135 percent of the federal poverty level). He would no longer include life insurance policies in the equation.

Marylou Sudders, the secretary of health and human services, with Kathy Paul of Lynn. (Photo by Sarah Betancourt)

An additional 25,000 seniors would be eligible to join the program, with 15,000 more having expanded assistance. The $10 million proposed as new state investment in the program would trigger over $100 million in federal funds.

Enacting the budget provision would impact 70-year-old John Robinson of Somerville. The retired porter and cleaner for Amtrak would see his out-of-pocket health care costs drop to 16 percent of his monthly income, down from 26 percent. Robinson doesn’t have many choices – he has been legally blind in one eye since infancy, and has reduced sight in the second.

He pays $438 a month for health insurance, including prescription drug Class D benefits, and a supplemental Medigap insurance. With the passing of Baker’s budget, Robinson’s medical bills would plummet to $260 a month.

The Massachusetts Senior Action Council doesn’t want to stop at 165 percent of the federal poverty level; the group wants to go to 200 percent over three years. Doing that would reduce Robinson’s health care expenses even further to just 4 percent of his income.

The Massachusetts Health Connector has determined those under 200 percent of the federal poverty level should spend no more than 2.9 percent on healthcare.

The 200 percent federal poverty level expansion in the legislation Mass Senior Action Council just filed with lead sponsors Sen. Jason Lewis of Winchester and Rep. Steven Ultrino of Malden would completely close the eligibility gap between Connector Care and the Medicare Savings Program.

It would broaden the impact of Medicare Savings Programs beyond the 40,000 helped by the governor’s budget to 70,000 seniors.

Carolyn Villers, executive director of the Massachusetts Senior Action Council, said “individuals under 200 percent are the folks choosing between prescriptions and food, so we’ve prioritized.”

Nationally, Massachusetts is among the states with the greatest percentage of economically insecure elders, second only to Mississippi. Sen. Brendan Crighton of Lynn doesn’t like to be compared to Mississippi.

About Sarah Betancourt

Sarah Betancourt is a bilingual journalist reporting across New England. Prior to joining Commonwealth, Sarah was a reporter for The Associated Press in Boston, and a correspondent with The Boston Globe and The Guardian. She has written about immigration, social justice, and health policy for outlets like NBC, The Boston Institute for Nonprofit Journalism, and the New York Law Journal. Sarah has reported stories such as a national look at teacher shortages, how databases are used by police departments to procure information on immigrants, and uncovered the spread of an infectious disease in children at a family detention center. She has covered the State House, local and national politics, crime and general assignment.

Sarah received a 2018 Investigative Reporters and Editors Award for her role in the ProPublica/NPR story, “They Got Hurt at Work and Then They Got Deported,” which explored how Florida employers and insurance companies were getting out of paying workers compensation benefits by using a state law to ensure injured undocumented workers were arrested or deported. Sarah attended Emerson College for a Bachelor’s Degree in Political Communication, and Columbia University for a fellowship and Master’s degree with the Stabile Center for Investigative Journalism.

About Sarah Betancourt

Sarah Betancourt is a bilingual journalist reporting across New England. Prior to joining Commonwealth, Sarah was a reporter for The Associated Press in Boston, and a correspondent with The Boston Globe and The Guardian. She has written about immigration, social justice, and health policy for outlets like NBC, The Boston Institute for Nonprofit Journalism, and the New York Law Journal. Sarah has reported stories such as a national look at teacher shortages, how databases are used by police departments to procure information on immigrants, and uncovered the spread of an infectious disease in children at a family detention center. She has covered the State House, local and national politics, crime and general assignment.

Sarah received a 2018 Investigative Reporters and Editors Award for her role in the ProPublica/NPR story, “They Got Hurt at Work and Then They Got Deported,” which explored how Florida employers and insurance companies were getting out of paying workers compensation benefits by using a state law to ensure injured undocumented workers were arrested or deported. Sarah attended Emerson College for a Bachelor’s Degree in Political Communication, and Columbia University for a fellowship and Master’s degree with the Stabile Center for Investigative Journalism.

“I don’t want us to be included with Mississippi on any policy, especially for our seniors,” he said. “The governor has made a good start. We have to get to the full amount.”

The Baker administration may be open to that. At a Mass Senior Action advocacy day on Tuesday, Sudders said she hopes the administration can increase the eligibility pool further but to “ask next year,” as state finances can change. Sudders said she’s “glad the governor’s budget can address a long-standing issue,” and that seniors can “count on her budget testimony” in any upcoming hearings.